Some women with abnormal breast lesions may avoid surgery

Main Category: Breast Cancer
Article Date: 01 Aug 2013 - 1:00 PDT
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Some women with abnormal breast lesions may avoid surgery

Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a new study published online in the journal Radiology. Researchers said that periodic imaging and clinical exam are effective in these patients when radiology and pathology findings are benign and concordant, or in agreement.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are abnormal breast lesions that occasionally appear as incidental findings in breast biopsies. Women with ALH or LCIS have a four to 10 times higher risk of developing breast cancer, according to Michael A. Cohen, M.D., FACR, professor of radiology at the Emory University School of Medicine in Atlanta. As a result, it is often recommended that ALH and LCIS diagnosed on image-guided core biopsy be removed surgically.

"Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise ALH and LCIS," Dr. Cohen said.

But new research from Dr. Cohen, Kristen Atkins, M.D., and colleagues may alter that thinking.

Dr. Atkins is a pathologist and associate professor at the University of Virginia in Charlottesville, Va. At one time, Drs. Cohen and Atkins were colleagues there and had many discussions about balancing the risk of cancer in ALH and LCIS patients with the costs and potential complications of surgery.

"From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised," Dr. Atkins said. "These surgeries may involve general anesthesia and possible disfigurement."

The researchers studied 10 years of pathology and radiology data to look for a correlation between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow up and the concordance between the radiologist and pathologist.

The research yielded 50 cases from 49 women aged 40 to 73 years. Radiologist and pathologist findings were concordant in 43 of the 50 cases. None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ, or DCIS, an early-stage, noninvasive form of breast cancer.

Dr. Cohen repeated the study after moving to Emory and found the same results.

"When there's no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there's no upgrade from ALH or LCIS to cancer in our study," Dr. Cohen said. "These findings show that some women can avoid surgery, and that yearly mammograms along with MRI or ultrasound as second-line screening tools may suffice."

The researchers suggested that their findings will help physicians and patients make informed decisions about ALH and LCIS.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject.

"Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation." Collaborating with Drs. Cohen and Atkins were Brandi Nicholson, M.D., and Sandra Rao, M.D.

For patient-friendly information on mammography, MRI and ultrasound, visit RadiologyInfo.org.

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Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Public Health
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion

In an epidemic or a bioterrorist attack, the response of government officials could range from a drastic restriction of mobility - imposed isolation or total lockdown of a city - to moderate travel restrictions in some areas or simple suggestions that people remain at home. Deciding to institute any measure would require officials to weigh the costs and benefits of action, but at present there's little data to guide them on the question of how disease spreads through transportation networks.

However, a new MIT study comparing contagion rates in two scenarios - with and without travel restrictions - shows that even moderate measures of mobility restriction would be effective in controlling contagion in densely populated areas with highly interconnected road and transit networks. The researchers called the difference between infection rates in the two scenarios the "price of anarchy," a concept from game theory that's frequently used as a metric in studies of the controlled use of transportation networks.

The study, published online July 31 in the Journal of the Royal Society Interface, is the first to link the concept of price of anarchy to the spread of contagion. It assumes that transmission of the news of the epidemic (which influences how people select travel routes) and the epidemic itself follow the same mobility network, and uses standard epidemiological models to simulate the flow of contagion.

The researchers - Ruben Juanes, the ARCO Associate Professor in Energy Studies in MIT's Department of Civil and Environmental Engineering, graduate student Christos Nicolaides and research associate Luis Cueto-Felgueroso - used data from the 2000 U.S. census to establish the aggregate daily flux of people commuting between counties.

Previous research had shown that when individuals become aware of an epidemic, they travel not by taking the shortest route, but by taking the shortest route that avoids infected areas - even if they're already infected - a strategy that exposes people in uninfected areas to disease. Such "selfish behavior," as it's called in game theory, is in direct opposition to the strategy of policymakers, who presumably would act in the benefit of the greater social good by routing infected individuals through areas where infection rates were already high.

The MIT study shows that the price of anarchy in some regions of the United States, such as along Interstate 95 in the Northeast, would be considerable. For a moderately contagious disease - one in which every infected person infects, on average, two others - restricting individuals to specific travel routes would decrease infection rates by as much as 50 percent.

"In an area with high connectivity, the outcome of action coordinated by officials is going to be better than selfish action, but the economic and social costs of disruption could sometimes be too high," Juanes says. "In other cases, there would be an enormous benefit to having authorities impose travel restrictions. The price of anarchy is a quantitative measure that identifies areas where intervention might pay off."

"Although the study is an idealized scenario, it does give insight to authorities about when and where it would be important to impose route restrictions on human mobility in the case of an emergent outbreak or in the extreme case of bioterrorism," says Nicolaides, the paper's first author, who was funded by a Vergottis Fellowship from the MIT School of Engineering. "But you have to take into account the structure of the underlying mobility network and its traffic properties. Imposing policy-initiated action in areas with low traffic would not render substantial benefits for the containment of an epidemic."

In their models, the researchers tracked an infectious disease as it spread via commuting networks in the contiguous United States, and found that the price of anarchy for contagion varies depending on the proximity of a network to major commuting corridors.

"A commuting network may be very local, but some contagion is related to more distant travel networks," Cueto-Felgueroso says. "That's why we see a higher price of anarchy near major arteries, like Interstate 95 in the northeastern United States."

The researchers had previously studied the spread of disease through the air transportation network and found that the interconnectivity and location of an airport in the network, not just the number of travelers moving through it, were key to its ability to spread disease.

Juanes says the next step in this work is to measure the price of anarchy for contagion in the world's 7,000 airports.

Written by Denise Brehm

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Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 01 Aug 2013 - 13:00 PDT Current ratings for:
Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness

A study suggests that after aesthetic facial plastic surgery the average number of apparent"years saved" (true age minus guessed age) was 3.1 years but there was only an insignificant increase in attractiveness scores, according to a report published by JAMA Facial Plastic Surgery, a JAMA Network publication.

Patients seek out aesthetic facial surgery to look younger and more attractive but there is minimal literature about the effect of the surgery on perceived age and attractiveness, according to the study background.

A. Joshua Zimm, M.D., of the Lenox Hill Hospital and Manhattan Eye, Ear & Throat Institute of North Shore-LIJ Health System, New York, and colleagues quantitatively evaluated the degree of perceived age change and improvement in attractiveness following surgical procedures.

Independent raters examined preoperative and postoperative photographs of 49 patients who underwent aesthetic facial plastic surgery between July 2006 and July 2010 at a private practice in Toronto, Canada. The photographs were shown to 50 blind raters. Patients in the study ranged in age from 42 to 73 years at the time of surgery with an average age of 57 years.

On average, raters estimated their patients' ages to be about 2.1 years younger than their chronological age before surgery and 5.2 years younger than their chronological age after surgery. The average overall years saved following surgery was 3.1 years, according to the results. There also was a small and insignificant increase in attractiveness scores in postprocedural photographs, the results indicate.

"In conclusion, the subjective nature of facial rejuvenation surgery presents a challenge in the assessment of successful results," the study concludes. "Given the limitations of the attractiveness component of this study as described herein, further investigation is warranted to verify these findings."

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JAMA Facial Plast Surg. Published online August 1, 2013. doi:10.1001/jamafacial.2013.268.

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Tisch MS researchers announce breakthrough in disease monitoring

Main Category: Multiple Sclerosis
Article Date: 01 Aug 2013 - 2:00 PDT Current ratings for:
Tisch MS researchers announce breakthrough in disease monitoring

A research team lead by Violaine Harris, Ph.D., at the Tisch MS Research Center of New York, has just published findings on a new method of measuring disease activity in patients with multiple sclerosis (MS).

This important biomarker discovery is based on spinal fluid measurement of Fetuin-A levels obtained over the course of several years of clinical and pathological studies of MS patients as well as experimental models of the disease. Dr. Harris's findings are likely to change the process for making treatment decisions in MS patients.

Current MS treatment is designed to stop disease activity in the brain and spinal cord with the goal of arresting disease progression and disability. According to Dr. Saud A. Sadiq, the senior author on the study, "these findings will provide a measurable method of monitoring the effectiveness of treatment much like determining blood sugar levels are assayed for diabetic patients. Many patients with MS on treatment report 'worsening' despite stable MRI findings. Addition of Fetuin-A measurement will help better evaluate disease activity in such patients."

The Tisch MS Research Team continues to study the underlying mechanisms of elevation of spinal fluid Fetuin-A to determine its exact role in multiple sclerosis.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Cerebrospinal fluid fetuin-A is a biomarker of active multiple sclerosis, Multiple Sclerosis Journal, Epub: 2/25/2013 doi: 10.1177/1352458513477923 ahead of print.

The Tisch MS Research Center of New York

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posted by Dr Zinia Thomas on 1 Aug 2013 at 5:10 am

Fetuin-A levels is very much important to monitor a disease. It is important because if you can't properly monitor the disease treatment will goes wrong.

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'Tisch MS researchers announce breakthrough in disease monitoring'

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Tomosynthesis reduces breast cancer screening recall rate

Main Category: Medical Devices / Diagnostics
Also Included In: Breast Cancer
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Tomosynthesis reduces breast cancer screening recall rate

Digital tomosynthesis is an effective tool for reducing the recall rate in breast cancer screening, according to a new study published online in the journal Radiology.

Digital mammography is the gold standard for breast cancer screening, but may yield suspicious findings that turn out not to be cancer. These false-positive findings are associated with a higher recall rate, or the rate at which women are called back for additional imaging or biopsy.

Digital breast tomosynthesis has shown promise at reducing recall rates, particularly in younger women and in those with dense breast tissue. Tomosynthesis is similar to mammography in that it relies on ionizing radiation to generate images of the breast. However, unlike conventional mammography, tomosynthesis allows for three-dimensional (3-D) reconstruction of the breast tissue, which can then be viewed as sequential slices through the breast.

"Tomosynthesis increases the conspicuity of cancers by removing superimposed and overlapping tissue from the view," said Brian M. Haas, M.D., from Yale University School of Medicine in New Haven, Conn.

In the study, Dr. Haas worked with Liane E. Philpotts, M.D., also of Yale University, and other colleagues to compare screening recall rates and cancer detection rates in two groups of women: those who received conventional digital mammography alone and those who had tomosynthesis in addition to mammography.

Of the 13,158 patients who underwent screening mammography, 6,100 received tomosynthesis. The cancer detection rate was 5.7 per 1,000 in patients receiving tomosynthesis, compared with 5.2 per 1,000 in patients receiving mammography alone. The addition of tomosynthesis resulted in a 30 percent reduction in the overall recall rate, from 12.0 percent for mammography alone to 8.4 percent in the tomosynthesis group.

"All age groups and breast densities had reduced risk for recall in the tomosynthesis group," Dr. Haas said. "Women with dense breasts and those younger than age 50 particularly benefited from tomosynthesis."

Lower recall rates help reduce patient anxiety and also reduce costs from additional diagnostic examinations, Dr. Haas said.

Tomosynthesis has one significant drawback: a radiation dose approximately double that of digital mammography alone. However, Dr. Haas noted that new technology approved by the U.S. Food and Drug Administration could reduce the dose.

"The technology involves taking the tomosynthesis data and collapsing it into planar imaging that resembles 2-D mammography," he said. "It has the potential to eliminate the need for acquisition of the conventional 2-D images in addition to the tomosynthesis images."

The research group is currently in the process of comparing the cancers found on tomosynthesis with those found on mammography. They are also tracking the study group for interval cancers - those that develop in the interval between screenings - to make sure that the reduced recall rate associated with tomosynthesis is not resulting in missed cancers.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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"Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening." Collaborating with Drs. Haas and Philpotts were Vivek Kalra, M.D., Jaime Geisel, M.D., Madhavi Raghu, M.D., and Melissa Durand, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc.

RSNA is an association of more than 51,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on breast imaging, visit http://radiologyinfo.org.

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Transcription and replication result in distinct epigenetic marks following repression of early gene expression

Main Category: Genetics
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Transcription and replication result in distinct epigenetic marks following repression of early gene expression

DNA in higher organisms is packaged by proteins known as histones. In response to external factors, the histones can be tagged at precise locations by addition of methyl groups that are read to regulate the expression of genes associated with the DNA. It has been thought that when a cell divides, the location of the methyl groups in these histones is duplicated along with the DNA.

Recent work from Barry Milavetz's laboratory group at the University of North Dakota now suggests that this may not always be the case. In the histones of simian virus 40, which are very similar to cellular histones, when the DNA is duplicated methyl groups may be introduced at new sites in response to external factors. In other words, an external factor can dictate the precise location of the tags based on whether the gene is being expressed or duplicated. Therefore, the duplication of DNA may serve to allow switching of the location of methyl groups with a subsequent change in the potential expression of the genes in the DNA associated with the newly modified histones.

This result may help to explain why there are so many forms of histone methylation. The introduction of methyl groups when DNA is duplicated may play an important role during development, say the authors.

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"Transcription and Replication Result in Distinct Epigenetic Marks Following Repression of Early Gene Expression", Les Kallestad, Emily Woods, Kendra Christensen, Amanda Gefroh, Lata Balakrishnan and Barry Milavetz, Front. Genet. 4:140. DOI: 10.3389/fgene.2013.00140

Frontiers in Genetics

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UK government's delay on plain tobacco packaging: how much evidence is enough?

Main Category: Smoking / Quit Smoking
Article Date: 01 Aug 2013 - 0:00 PDT Current ratings for:
UK government's delay on plain tobacco packaging: how much evidence is enough?

On bmj.com today, senior research fellow Crawford Moodie asks how much more evidence is needed before the UK government make a decision on plain tobacco packaging.

In July, the UK government announced that there would be a delay on the decision on plain packaging, until findings from Australia emerge. The first study from Australia published since plain packaging came into effect found that smokers who used plain packs perceived their cigarettes to be "less satisfying and poorer quality" and "were more supportive of plain packaging and more likely to think about and to prioritise quitting".

Past research shows that desire to quit is a "reliable predictor" of whether someone tries to stop smoking with studies showing that high motivation is an important factor in quitting.

Moodie draws on the findings from the Australian study which he says supports one of the UK Government's public health policy priorities, namely to encourage smokers to quit, but questions whether they are enough to influence UK policy. He says that there is a "rapidly growing body of evidence on this issue" which is consistent in its findings: plain packaging would reduce appeal; increase the effectiveness of health warnings and reduce the ability of packaging to mislead consumers about the harmful effects of smoking.

The European Parliament's Committee on the Environment, Public Health and Food Safety supports pictorial health warnings covering 75% of the front and back of tobacco packaging, which should help reduce "pack appeal, enhance the visibility of warnings and disrupt tobacco companies' ability to communicate with consumers". However, Moodie argues that larger warnings would "not be enough" to prevent manufacturers using the "design of packaging and branding to detract from these warnings" or prevent consumers "being confused about the harms of the products". He points to the Framework Convention on Tobacco Control, which suggests that "only plain packaging can do this".

Moodie says that most smokers become addicted to smoking in childhood and recent figures show that the habit among children continues to fall in England and has steadily fallen since the introduction of tobacco control measures outlined in the 1998 white paper Smoking Kills. He adds however, that there is no guarantee, "this decline will continue if a tobacco control strategy is not sustained".

He concludes that as packaging is the "key marketing and communications tool for tobacco companies" since advertising, promotion and sponsorship was banned, "standardised packaging would appear to be a logical next step".

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